your Loan Bank

Consumer Credit Application

Important Applicant Information: Federal law requires
financial institutions to obtain sufficient information to verify your identity.
You may be asked several questions and to provide one or more forms of identification
to fulfill this requirement. In some instances we may use outside
sources to confirm the information. The information you provide is
protected by our privacy policy and federal law.

Type of Credit
Requested

Secured

Individual
Credit - relying solely on my income or assets

Unsecured

Individual
Credit - relying on my income or assets as well
as income or assets from other sources, including
community property

Joint
Credit - We intend to apply for joint credit

Initials

Joint Initials

Amount Requested

For How Long

Payment Date Desired

Desired Repayment

Proceeds of Loan to Be Used For

Monthly

Other

For Creditor Use Only

Date

Account No

Approved

Declined

By

Section A - Individual Applicant Information

Name
(First, Middle, Last)

Birth
Date

Telephone
Number

Email Address

Cell Phone
Number

Driver's
License No

Social Security
Number

Number of
Dependents

Ages of
Dependents

Address
(Street, City, State, & ZIP)

County

Do you
Own
or
Rent

How Long

Previous Address
(Street, City, State, & ZIP) (Complete if less than
3 yrs at current address)

County

Did you
Own
or
Rent

How Long

Employer
(Company Name & Address)

How Long

Business Phone

Position or
Title

Salary / Month
Gross $

Net $

Alimony, child support, or
separate maintenance income need not be revealed if you
do not wish to have it considered as a basis for
repaying this obligation.Alimony, child support, separate maintenance
received under
Court Order
Written Agreement
Oral Understanding

Sources of
Other Income

Amount per Month $

Is any income listed in this section
likely to be reduced before the credit requested is paid
off?

Have you previously received credit from
us?

No
Yes
(Explain)

No
Yes
(When)

Name & address of nearest relative not
living with you

Relationship

Telephone

Section B - Joint Applicant or Other Party Information

Complete only if: for joint credit, for individual
credit relying on income or assets from other sources, or
applicant is married and resides in a community property state.

Name
(First, Middle, Last)

Birth
Date

Telephone
Number

Email Address

Cell Phone
Number

Driver's
License No

Social Security
Number

Number of
Dependents

Ages of
Dependents

Address
(Street, City, State, & ZIP)

County

Do you
Own
or
Rent

How Long

Previous Address
(Street, City, State, & ZIP) (Complete if less than
3 yrs at current address)

County

Did you
Own
or
Rent

How Long

Employer
(Company Name & Address)

How Long

Business Phone

Position or
Title

Salary / Month
Gross $

Net $

Alimony, child support, or
separate maintenance income need not be revealed if you
do not wish to have it considered as a basis for
repaying this obligation.Alimony, child support, separate maintenance
received under
Court Order
Written Agreement
Oral Understanding

Sources of
Other Income

Amount per Month $

Is any income listed in this section
likely to be reduced before the credit requested is paid
off?

Have you previously received credit from
us?

No
Yes
(Explain)

No
Yes
(When)

Name & address of nearest relative not
living with you

Relationship

Telephone

Section C - Marital Status

Complete only if: for joint or secured credit, or
applicant resides in a community property state or is relying on
property located in such a state as a basis for repayment of the
credit requested.

Applicant

Married
Separated
Unmarried (includes single, divorced and widowed)

Other Party

Married
Separated
Unmarried (includes single, divorced and widowed)

Section D - Assets & Debt Information

If Section B has been completed, this section should
be completed giving information about both the Applicant and
Joint Applicant or Other Person.
Please mark Applicant-related information with an "A". If
Section B was not completed, only give information about the
Applicant in this section.

Complete the following information about both the Applicant and Joint Applicant or Other Person (if applicable):

Are you obligated to make Alimony, Support or Maintenance Payments?

No
Yes

If yes, to (Name & Address)

Amt. per month $

Are you a co-maker, endorser, or guarantor on any
loan or contract?

No
Yes

If yes, for whom?

To whom?

Are there any unsatisfied judgments against you?

No
Yes

If yes, to whom owed?

Amount $

Have you been declared bankrupt in the last 10
years?

No
Yes

if yes, where?

Year?

Notice to Married Applicants:
No provision of any marital property agreement,
unilateral statement under Wisc. Statutes §766.59 or a
court decree under Wisc. Statutes §766.70 adversely
affects the interest of the creditor unless the
creditor, prior to the time the credit is granted, is
furnished a copy of the agreement, statement or decree
or has actual knowledge of the adverse provision when
the obligation to the creditor is incurred.

Section E - Secured Credit

Complete only if credit is to be secured.
Briefly describe the property to be given as security:

Property Description

Names & Addresses of All Co-Owners of the Property

If the security is real estate, give the full name of
your spouse (if any)

Signatures -

I certify that everything I have stated in this application and on any attachments is correct. Lender may keep this application whether or not it is approved. By signing below I authorize Lender to check my credit and employment history and to answer questions others may ask Lender about my credit record with Lender. I understand I must update credit information at Lender's request if my financial condition changes.